title: Thoracoscopic Nuss procedure for young adults with pectus excavatum: excellent midterm results and patient satisfaction.
abstract: BACKGROUND
  Chest wall remodeling by substernal placement of a Nuss bar is the treatment of choice for children with pectus excavatum; however, it has not yet gained widespread acceptance in adults. We demonstrate that thoracoscopic Nuss bar insertion in young adults is safe and leads to excellent results.
  
  
  METHODS
  Adult patients who underwent thoracoscopic Nuss bar insertion at one institution between 2006 and 2012 were identified. Data on demographics, postoperative outcomes, quality of life, and cosmetic satisfaction was collected. A validated single-step quality of life survey was administered to patients. Student's t test and the Wilcoxon rank sum test were used for statistical analysis.
  
  
  RESULTS
  Seventy-three patients (65 male, 8 female) with a median age of 20 years (range, 16 to 51) were included. The median follow-up was 44.6 months (range, 36.9 to 73.26). Most patients (59 of 73, 81%) had one bar placed. The median length of hospital stay was 5 days (range, 3 to 9) and the median duration of epidural anesthesia was 3 days (range, 0 to 7). There were 4 reoperations (5.5%) in the immediate postoperative period: 2 for bar displacement and 2 for poor cosmesis. All reoperations were performed thoracoscopically. Other postoperative complications included pneumothorax (3 of 73, 4.1%) and ileus (1 of 73, 1.3%). Fifty-one patients participated in a quality-of-life survey (73% response rate). The mean self-esteem score improved from 4.6 of 10 preoperatively to 6.5 of 10 postoperatively (p=0.002). The social impact of the pectus deformity became less significant (mean preoperative score 3.6, mean postoperative score 2.8, p=0.02). The severity of initial postoperative pain was much improved on follow-up. The vast majority of patients (41 of 51, 80%) were satisfied with the cosmetic result, and 96% (49 of 51) would opt to have the surgery again.
  
  
  CONCLUSIONS
  For young adults who wish to correct their pectus deformity, a thoracoscopic Nuss procedure is safe and results in a high rate of patient satisfaction, significant improvement in self-image, and excellent midterm cosmetic results.
authors.affiliation: St. Joseph's Health Centre, University of Toronto, Toronto, Ontario, Canada. wael.hanna@me.com
authors.forename: Waël C
authors.initials: WC
authors.lastname: Hanna
authors.forename: Michael A
authors.initials: MA
authors.lastname: Ko
authors.forename: Maurice
authors.initials: M
authors.lastname: Blitz
authors.forename: Yaron
authors.initials: Y
authors.lastname: Shargall
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Compeau
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D004954:Esthetics; D005260:Female; D005500:Follow-Up Studies; D005660:Funnel Chest / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D019736:Prostheses and Implants; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D020775:Thoracic Surgery, Video-Assisted / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: 5